Delay in diagnosis and treatment of colorectal cancer in Alexandria Main University Hospital

Mean delay between the onset of symptoms and treatment was 18.5 months in 30 patients with colonic carcinomas and 16.7 months in 60 patients with rectal carcinomas. Most of this delay occurred outside the hospital and delay attributable to the patient was more than attributable to general practitioners. Although delay related to incorrect surgical management resulted in a shorter pre-hospital delay but added a serious part to it. Patient delay is largely the result of not knowing the importance of bowel symptoms, while delay with general practitioner was the result of not examining the rectum of patients with possible carcinomas and not recognizing symptoms suggestive of colonic carcinoma. 16.6% of the patients admitted for emergency treatment, all of them consulted their doctor about symptoms on one or more occasions. Hospital delay consisted mainly of waiting for investigation, poor quality barium enemas, inadequate simgoidoscopies or insufficient biopsies. There was no relation between the duration of symptoms and the Duke's stage of the tumor

Study of the effect of longacting somatostatin analogue, octreotide on acute bleeding from oesophageal varices

A placebo-controlled clinical trial of octreotide was conducted among 30 patients admitted for bleeding oesophageal varices. [15 placebo 15 octreotide]. An octreotide infusion at a dose of 50 ug/hour for 24 hours and an identical administration of placebo were evaluated for the control of bleeding over the 24 hours trial period. Patients of both groups were comparable in age, gender, severity of liver disease, history of variceal bleeding as well as the grade of their oesophageal varices. Initial control of bleeding occurred in 14/15 patients [93.3%] in the octreotide group after a mean time of 3.93 +/- 2.87 hours, while in placebo this occurred in 9/15 patients [60%] after a mean 3 +/- 1.58 hours. Severe rebleeding after initial response occurred in 3/14 [21.14%] in the octreotide group and 4/9 [44.4%] in the placebo group. Transfusion requirements were similar in both groups and no complications occurred could be attributed to the trial drug. It is concluded that octreotide is safe and more effective than placebo for the control of variceal bleeding until definitive treatment can be undertaken

Estrogen receptor assay in colonic schistosomal polyps

The estrogen receptors were quantitated in the cytosolic and nuclear fractions in schistosomal colonic polyps of 20 patients, ten schistosomal mucosae and ten normal control mucosae. Cytosolic estrogen receptors [cer] were found in 85% of polyps while nuclear estrogen receptors [ner] were found in only 15% of the polyps together with the cer. The binding capacity of the cer in polyps ranged from 24.8 to 1197.2 f mol/mg protein with a mean of 273.35 fmol/mg protein and for the ner it ranged from 130.8 to 851.7 fmol/ml protein with a mean of 425.8 fmol/mg protein. The concentration of cer in the surrounding mucosa varied from 10 to 225 fmol/mg protein with a mean of 133.75 fmol/mg protein. While that of mer varied from 80 to 555 fmol/mg protein with a mean of 328.333 mg protein in the mucosa surrounding the polyps. In colonic mucosa of 10 controls, ner were found in 40% of cases, while ner were found in only 20% of cases. The binding capacity of cer ranged from 21 to 166 fmol/mg protein with a mean of 75.5 fmol/mg protein, while the mean of ner was 180 fmol/mg protein. The incidence and concentration of ER were higher in young age groups of patients, and in those with hyperplastic or dysplastic changes and with large sized polyps. This may reveal a hormonal influence on schistososmal polyps

Combined rubber band ligation and local phenol injection versus either band ligation or sclerotherapy in treatment of internal hemorrhoids

Two hundred and fifty patients with first and second degree hemorrhoids were randomly allocated to combined rubber b and ligation and local phenol injection [100 cases], rubber b and ligation alone [100 cases] and sclerotherapy alone [50 cases]. In the group treated by rubber b and ligation alone, there was slipping of the b and in 44% of cases either during or shortly after the procedure and 5% suffered secondary hemorrhage. In the group treated by combined rubber b and ligation and local phenol injection, no case showed slipping of the b and s nor postoperative hemorrhage. Phenol injection increased the tension in the ligated pile preventing slipping of the b and. It also speeded up the necrotizing process and decreased the incidence of secondary hemorrhage. In the group treated by sclerotherapy, there was a higher incidence of pain and persistence of symptoms than the other groups. The technique of combined rubber b and ligation and local phenol injection overcomes most of the side effects of either sclerotherapy or rubber b and ligation alone

Postpartum Lord's procedure treatment of anal fissures and/or hemorrhoids

200 pregnant females with anal fissure and/or haemorrhoids were randomly divided into two equal groups [A] and [B]. Patients of group [A] were subjected to Lord's procedure under local anaethesia immediately after delivery while patients of group [B] were studied as controls. 90.9% of patients with anal fissure and 83.65% of patients with haemorrhoids were rendered either symptom free or experienced great improvement after dilatation. Transient faecal soiling and transient incontinence to flatus were the commonest complications seen following Lord's procedure. However, they rectified themselves spontaneously within 4 to 6 weeks. Lord's procedure is recommended as the method of choice for the treatment of anal fissures and/or haemorrhoids in pregnancy in the immediate post-partum period

effect of preoperative chemotherapy in locally advanced breast cancer

20 female patients with stage III breast carcinoma [both operable and inoperable] without evidence of distant metastasis entered in this study. All patients received combination chemotherapy with cyclophosphamide, 5-fluorouracil and adriamycin as their initial form of therapy. After two cycles of chemotherapy, local treatment in the form of simple mastectomy with axillary dissection and radiotherapy was completed. Subsequently, adjuvant chemotherapy was continued. Assessment of the patient response to preoperative chemotherapy showed that 12 patients [60%] had achieved objective regression of the tumor size [25% to 44% of its largest diameter] and 6 patients [30%, achieved minor response [< 25% of its largest diameter]. On the other h and, 2 patients [10%] achieved no response but had stable disease. Follow up of the patients was done for 10 to 18 months. Two patients [10%] developed distant metastasis after 10 months. This study proved the efficacy of preoperative chemotherapy in reducing the size of the tumor in patients with locally advanced breast carcinoma to a sufficient degree to make it operable. The preliminary results from this study showed that, this combined modality regimen resulted in an excellent local control rate. The correlation of response and survival needs longer follow up

Peri-anal fistula: bidimensional clinical and operative study

The present work was carried out on 100 patients with perianal fistulae to study the relation between the topographic disposition of their external openings and the height of the fistulous track. A history of perianal abscess [PAA] was present in 89% of the cases, surgically drained abscesses resulted in a higher incidence of fistulae with blind extension. Intersphincteric [ISP] fistula was the predominant type, while high ISP fistula without perianal opening [submucous] was least common. No supra or extrasphincteric fistulae were found. 8% of the cases could not be classified according to Park's classification. Goodsall's rule was valid in the majority of cases but not always true. Fistulae located at the transverse line passing through the anus had no rule in their course. Fistulae posterior located at the transverse line passing through the anus had no rule in their course. Fistulae posterior to that line usually open at 6 O'clock, while anterior to it fistulae usually open directly except those with EO at a distance more than 2 cm from MCJ [where they may open posterior at 6 O'clock or anterior at 12 O'clock]

Value of serial serum carcinoembryonic antigen [CEA] determinations in patients with colo-rectal carcinoma

This study has been conducted on 30 patients with rectal or colonic carcinoma as well as on 10 normal controls. The mean CEA serum level in controls was 3.46 +/- 1.31 ug/L, while that preoperatively in patients was 64.07 +/- 60.16 ug/L. The mean postoperative CEA serum level in patients was 39.9 +/- 58.37 ug/L. This postoperative drop in the serum CEA level was significant. The highest preoperative serum CEA level was found in patients with Dukes, stage D, with a mean of 114.45 +/- 86.68 ug/L. Also, the highest level was found in patients with poorly differentiated tumors; mean 138.92 +/- 89.53 ug/L. Serial serum CEA determinations showed that there were no significant drop of preoperative serum CEA levels in 7 patients; 6 with stage D tumors and the seventh with stage C tumor. All these seven patients died within 2 years. In 11 patients of the remaining 23 patients the drop was to the normal range, with recurrence in 27.3% compared to 41,7% in the 12/23 patients who showed a drop to levels above the normal range. Also, 10/23 patients who showed re- rise of their serum CEA postoperatively had evidence of recurrence within 2 years, while the remaining 13/23 patients remained recurrence- free till the end of 2-years follow-up period. This showed the prognostic value of serial serum CEA determinations

Study of cytosolic and nuclear estrogen receptors in colorectal carcinoma

Cytosolic and nuclear estrogen receptors were assessed in 20 patients with colorectal cancer in the primary tumor tissue, non- cancerous mucosa and secondary deposits and also from colonic mucosa in 10 non cancerous patients. The primary tumors of 75% of cases contained significant concentration of estrogen. The percentage of ER + tumors was higher in males than females and higher in pre menopausal females than in post menopausal. Also, cases with locally-advanced tumors and with peritoneal deposits had more ER content. The right colon was higher in ER than other parts of the colon. From these results one can assume that estrogen and estrogen receptors may play a part in biological behavior of colorectal carcinomas

simple method for treating chronic post-operative anal stricture

Thirty patients with postoperative anal stenosis were treated by a simple operation which comprises a posterior longitudinal incision whose length depends on the level of stenosis, the flaps were dissected, then a wedge-shaped posterior internal sphincterectomy of the lower one third of the internal sphincter was made, followed by mucosal advancement over the internal sphincter and suturing the mucosa to the perianal skin transversely. Average time of healing was 12 days. Calibration of the anus using Hegar's dilators revealed a preoperative caliber of 13.4 +/- 4.3 and a postoperative one of 25.3 +/- 0.0

Effect of Disomine on haemorrhoids

This study was carried out on 150 patients suffering from hemorrhoids to evaluate the effect of disomine on hemorrhoids in the pre- and postoperative periods. The clinical and histopathological results proved the phlebotomic activity of the drug and its value in reducing congestion and edema. The study proved the value of disomine as a useful drug when used before hemorrhoidectomy and its value as a substitute for surgery when the latter is contraindicated. No side effects of the drug had been recorded

Biochemical markers in human breast cancer

This study was conducted on 50 patients with third stage breast carcinoma and 10 healthy females as controls. Serum levels of acute phase reactant proteins [APRPs] and transferrin as well as T-agglutinin titer were estimated in controls and in patients before and after surgery and/or radiotherapy. APRPs estimated were alpha 2-acid glycoprotein, alpha 1-antitrypsin, haptoglobin, ceruloplasmin, alpha 2-macroglobulin and prealbumin. All patients were treated by simple mastectomy and axillary clearance; 25 of them received postoperative deep X-ray therapy. Apart from alpha 2-macroglobulin, which did not show change, a significant change was found between the mean preoperative serum levels of APRPs and transferrin and T-agglutinin titer in patients with breast carcinoma compared to the controls. On the other hand, there was no significant change in the levels of these parameters between patients treated with surgery alone and those treated with radiotherapy in addition. This may be explained by the nature of the loco-regional treatment, which does not deal with the micrometastases and by suppression of the immune mechanism and points to the need for systemic therapy. This study points to the value of APRPs, transferrin and T-agglutinin as biological markers in patients with breast carcinoma and as monitors to assess the response to therapy

Surgical management of sacrococcygeal pilonidal disease

Four surgical operations were evaluated in this work on 120 patients with pilonidal sinus divided randomly into four groups. Group I patients was treated by open excision, group II patients by excision and primary closure, group III patients by excision, primary closure and closed suction drainage, while in group IV patients simple laying open of the sinus was only done. Although open excision technique was described to be the radical method of treatment of pilonidal sinus, it leaves the patient with a large raw area and great disability. This technique, beside its high morbidity, has a very lengthy post-operative period before complete healing of the wound. Such a wound was also found to be easy to break down after complete healing. Closure of the pilonidal wound without drainage was found to be associated with high incidence of post-operative sepsis which markedly mengthened the duration of hospital stay and healing. The use of closed suction drainage in draining the closed pilonidal wound markedly reduced the incidence of post-operative sepsis and resulted in rapid healing of the wound. So, we recommend excision and primary closure with closed suction drainage in cases with singlr midline, and also not grossly infected pilonidal sinus. Simple laying open technique with trimming of edge and curretage of the floor, is a safe procedure and results in minimal post-operative pain and ooze with little disability due to the relative small size of the wound. This technique is recommended for any case of pilonidal sinus particularly when it is infected, extensive or recurrent, and when the lateral secondary openings are far away from the midline. Post-operative day to day close observation of the wound with proper dressing and depilation of hair is thought to be one of the most important ways of success of operation

Evaluation of combined rubber band ligation and local phenol injection in treatment of internal haemorrhoids

One hundred patients with second or third degree hemorrhoids were randomly allocated to rubber band ligation [50] or combined rubber band ligation and local phenol injection [50]. Phenol injection after rubber band ligation had a success rate [92%] better than that of rubber band ligation alone [80%]. This phenol increased the tension in the ligated pile preventing slipping of the band. It speeded up the necrotizing process and helped to relieve discomfort. It also initiated immediate necrosis, which decreased postoperative pain and the incidence of secondary hemorrhage. The newly adopted technique of combined rubber band ligation and local phenol injection overcomes most of side effects and complications of rubber band ligation alone

Clinicopathological study and management of colorectal schistosomiasis

Polyposis of the colon and pericolic masses are common intestinal complications of schistosomiasis in Egypt. The heavy ovideposition in the submucosa with resultant schistosomal granulation tissue accounts for the polyposis coli, while such heavy deposition and classical schistosomal granuloma did not show in pericolic masses. Several trials for medical treatment of schistosomal polyposis or masses had been carried out, but, unfortunately no successful outcomes were attained. So, surgery remains the only weapon at hand for treatment of colonic schistosomiasis. Because of the actual risk of colonic leakage after a one-stage colonic resections and the technical difficulties encountered in performing the anastomosis, a three-staged surgical procedure for the treatment of patients with schistosomal colorectal polyposis or masses was evaluated and the encouraging results were obtained

Immunological aspects in patients with colorectal schistosomiasis

Recently, schistosomiasis is considered mainly as an immunological disease and it is essentially a cell-mediated immunity with a certain state of immunosuppression. In patients with schistosomal colorectal masses IgG and IgM showed significant elevation to undergo marked reduction after surgical resection of the mass or the polypi. Several mechanisms had been put to explain the preoperative raise of both IgG and IgM serum levels. After surgical treatment there was a significant decrease in migration inhibition index denoting increased sensitivity of T-lymphocytes to the soluble egg antigen [SEA], i.e. the cell-mediated immunity had regained some of its functions as measured by this parameter

Immunotherapy in patients with advanced cancer breast

Studies of the use of immunotherapy as an adjuvant modality in the multimodal treatment [RICH regime] of breast cancer indicated that it had a promising and strong effect. Immunotherapy alone is difficult to act, as it acts on a small number of tumor cell, thus, it should be used with other cytoreductive modalities. Patients receiving immunotherapy [lethally irradiated autografts from cancer cells and levamisole] showed improvement in humoral and cell-mediated immunity, recurrence-free interval and survival time after mastectomy. Immunotherapy, by the manner described in this work, is simple and well tolerated and leads us to advice its use on a wider scale